A Hypoglycemic emergency is defined as blood glucose less than 3.0 mmol \ L or 60 mg/dL and associated signs with symptoms, such as altered mental status.

EMT Standing Order

• Routine Patient Care.
• Obtain glucose readings via glucometer.
• Oral glucose: administer 1 tube of glucose gel, or other type of glucose form available in the system. The patient must be alert enough to swallow and protect the airway.
• Call for Paramedic intercept, if available.
• For patients with an insulin pump who are hypoglycemic with associated altered mental status (GCS < 15):
• Stop the pump or remove the catheter at the insertion site if the patient cannot ingest oral glucose or a paramedic is not available.
• Leave the pump connected and running if able to ingest oral glucose or receive ALS interventions.
• Do not treat and release hypoglycemic patients without contacting Medical Direction to discuss the cause of hypoglycemic episodes, interventions taken and follow-up plan.
• Call for AEMT/Paramedic intercept. & Assisst AEMT/Paramedic in patient care.

AEMT/Paramedic Standing Order

• Establish IV access.
• If AEMT/Paramedic was unable to establish IV access, administer glucagon IM. Recheck glucose 15 minutes after administration of glucagon.
  • patient < 20kg give glucagon 0.5mg IM
  • patient >20kg give glucagon 1 mg IM
• If glucagon not available and blood glucose is < 60 mg/dl (3.8 mmol) and patient is.
  • New Born -2 yrs old Consider Dextrose 25% 4ml/Kg IV/IO Repeat as needed
  • 2 yrs old Consider Dextrose 50% 2ml/Kg IV/IO Maximum 25gms per dose Repeat as needed.
  • If patient is in hypoglycemia and is unconscious, reassess the patient considering a deferential diagnosis (Do not give any thing by mouth).
  • Consider Advance airway If Inadequate Oxygenation/ventilation. Intubate with ETT ventilate and Confirm tube placement (as per or tracheal intubation protocol). If available attach waveform capnography to confirm tube placement.
  • Contact the Medical Director as early as possible.
  • If the patient is seizing manage as per seizer protocol If the patient has a severe hypoglycemic emergency with altered mental status or seizures and the provider is unable to establish IV access, the provider may administer dextrose 10% via intraosseous (IO).

PEARLS:

• Causes of hypoglycemia include medication misuse or overdose, missed meals, infection, cardiovascular insults, trauma, traumatic brain injury, hypothermia, adrenal insufficiency, or changes in activity (e.g., exercise).
• When administering dextrose, monitor the IV site for signs of extravasation.